One Man's Medicine: an autobiography of Professor Archie Cochrane

In AIMS we have many occasions to bless the name of Archie Cochrane as the Cochrane reviews are so extremely useful in the field of maternity services. I certainly have waved a printed out copy of a Cochrane Review in difficult meetings with health professionals as a kind of trump card.

Cochrane himself wasn’t particularly interested in childbirth but the Cochrane Collaboration, (which began in 1992/3) was preceded by a systematic review of pregnancy and childbirth, and went on to include more than 20,000 unpaid collaborators from 100 countries, so that posthumously Archie Cochrane has been recognised as being remarkably influential in health politics and a champion of the idea of looking for evidence on which to base health care.

This paperback is an edition published by Cardiff University to mark the centenary of his birth, the original was published in 1989 shortly before his death. It has additional contributions by Sir Richard Peto and Sir Iain Chalmers who are now able to evaluate his lasting contribution to the world of health care, which is now so firmly required to be evidence based.

His early life is interesting as an introduction to the man he would become, if fairly unremarkable, but becomes increasingly dramatic. Setting out for a career in clinical medicine and research in 1927, he was distracted by the Spanish civil war and interrupted his studies to spend time with a field ambulance unit, then spent four years as a POW medical officer in the German prison camps of World War Two. In desperation, in really dreadful conditions of semi starvation, which he describes calmly but with feeling, and with prisoners who were riddled with disease, he started to collect data and run simple trials and surveys to inform his work.

After the war he turned to epidemiology and evidence based-care. There is a suggestion that he was burnt out from caring, and in a fascinating aside explains that, as he had a private income, he was able to enter epidemiology, at that time, did not carry the merit award that bumped up and roughly doubled the salaries of his clinical counterparts.

Some of the details are noteworthy. As I said, his work was not in the field of maternity, in fact his main interest was pneumoconiosis, but at one stage, while challenging the consensus that early diagnosis leading to early treatment was always in the patient’s interest, he confesses a trick that he played on his colleagues. He was concerned to find out whether hospital treatment had better outcomes than outpatient and home treatment and to study cost effectiveness. He was randomising the place of treatment for ischaemic heart disease, as the cardiac consultants were sure that expensive coronary care units were saving lives.

Preliminary results showed slightly more deaths in the group treated in hospital so he reversed the figures. The doctors felt vindicated and said emphatically that he must stop the trial at once, allow no more home treatments and that his research was unethical. He then said that he had made a mistake and the higher death rate was in the hospital care unit. He waited to see whether they would insist on closing coronary care units but there was silence. No-one involved in the arguments against home births mounted by doctors will be surprised by this.Gill Boden

Beyond the Sling: a real-life guide to raising confident, loving children the attachment parenting way

I loved this book, it is such a child and family friendly approach to bringing up children! As parenting books go it is a rare combination of personal experience and research-based evidence. Bialik has lived, whilst parenting her own children, the research she is advocating. It creates a book that makes attachment-based parenting seem really accessible, fun and achievable. She says some interesting things, and nothing especially controversial, she simply puts parenting into her academic arena as a neuroscientist and evaluates it. Even her less mainstream-familiar chapters, such as the one on elimination communication, are grounded in research as well as personal evidence.

I agreed and identified with pretty much everything Bialik says, and I suspect if she were to turn up at a parenting group near me we would be friends!

I did find the language and style a bit ‘American’ and in some places quite directive, despite Bialik saying that she won’t be ‘preachy’, but I think that is largely a cultural difference in style, combined with her evident enthusiasm for the subject, rather than Bialik opting for the ‘my way or the highway’ approach favoured by some parenting guides.

Whilst some of the concepts might be written off in some circles as a bit ‘hippy’ everything said in this book comes with a wealth of quality evidence to support it, and I would recommend it to any new parent whether they are planning that style of parenting or not.

I loved what she said about breastfeeding, especially how strongly she stresses the importance of surrounding yourself with good support. Even though the organisations she talks about operate a little differently in the UK, the principles are the same, and looking for local support is worth it on every level!

My only major worries about the book are both in the chapter on ‘keeping your relationship strong’. Firstly, Bialik is separated from the father of her children, although they do seem to have a shared-parenting relationship that would be envied by many separated parents! My concern here is that as one of the well-used criticisms of child-centred parenting is that parents need time away from their children and mothers should take responsibility for the marital relationship, it would be a shame if this book’s message were to play into this view. Secondly, and this is interestingly the part where I have found most disagreement amongst child-centred parents, is her firm assertion that sex is not possible when sharing a family bed with a child. Views on this subject, as well as personal experiences, seem to be more varied than over any other topic covered in the book, topping even the chapter on nappy-free babies! The general consensus is that babies sleep through anything, toddlers can be moved if necessar y, and if a child is going to wake up and disturb you they will, wherever they are sleeping, even if you have locked your door…Vicki Williams

Why your baby's sleep matters

Sarah’s book, part of a Why It Matters series of essential evidence-based guides to pregnancy, birth and parenting, by Pinter and
Martin, is described as ‘science-rich yet easy-to-read’ which just about sums it up. She is rightly, in my view, critical of the baby sleep industry and ‘sleep experts’, many of whom are medical doctors who appear to have little knowledge of living with babies and any
notion of mothering.

I particularly liked her pen-portrait of possibly the first expert, Dr. Luther Emmett Holt, a pediatrician who advocated a rigid parent-led feeding schedule, making babies cry regularly to exercise their lungs and teach them not to be manipulative. His ideas presumably influenced the famous Truby King, who ushered in what she calls ‘the parent centric years’, 1890 – 1949. She tracks the rise of the ‘child centric years’, 1940 – mid 1980s, with the psychoanalytic views of Bowlby and Winnicot followed on by Spock and Penelope Leach then links the resurgence of the parent-centric attitudes which have re-emerged since 1980 with social changes including a rise in female employment.

This resurgence is bolstered by Dr Richard Ferber, an American pediatrician who is author of an infamous book, Solve your Child’s Sleep Problems published in 1985 which remains a perennial best seller : his name gives rise to the word ‘Ferberisation’, or ‘cry it out’, advice which is echoed by Gina Ford author of the Contented Little Baby Book.

In Why Your Baby’s Sleep Matters the evidence for how babies actually sleep and what to expect is set out clearly in a way that will help new parents. It also covers naps, night weaning, coping with tiredness and SIDS, and the lack of evidence for the current advice against co-sleeping and bed sharing.

One point I found particularly fascinating was the suggestion that the prevalent view that the ‘Back to Sleep’ campaign was responsible for drastically lowering the rate of cot deaths doesn’t fit all the facts. An increase in breast-feeding, a decrease in maternal smoking, more
awareness of how to co-sleep safely and a gradual decline in early weaning also accompanied the decline in SIDS.

There is a section on how mothers have managed their babies in the past and around the world. An example with lovely quotes compares Mayan mothers’ cultural practices with North American mothers, where the Mayan mothers had no complaints about night feeds since they breast fed while asleep in most cases and expressed ‘alarm, dismay, pity and sadness at the idea of the infants sleeping alone’.

The book finishes with stories from mothers, which remind me of the pleasures of being the mother of a new baby. I enthusiastically recommend this book for any new parents.Gill Boden